With summer and the World Cup in full swing, millions of Americans are hitting the road, booking flights, and planning getaways. Unfortunately, many of them are heading out without a clear understanding of what their health insurance plan actually covers while they travel.
Sean Colrick, CEO and co-founder of OneHealth Plus, is urging travelers to take a few minutes to review their coverage before they leave home.
Most people assume their health plan works the same everywhere, but it often doesn’t. Many individual health plans, especially those purchased through state marketplaces and ACA exchanges, are built on Health Member Organization (HMO) and Exclusive Provider Organization (EPO) networks that restrict coverage to local, in-network providers. If you travel out of your plan’s service area and need care that isn’t a true medical emergency, those plans may provide little or no coverage. Even a minor illness, a prescription refill, or a visit to an urgent care clinic could result in unexpected out-of-pocket costs.
“Medical emergencies can happen at any time, and without proper coverage, the cost of care can be overwhelming,” Colrick said. “Before you pack your bag, take a few minutes to understand what your plan covers and what it doesn’t. A little preparation can save you thousands.”
Emergency Care vs. Non-Emergency Care: Know the Difference
Under federal law, health plans are generally required to cover true emergency care regardless of whether a provider is in-network. But not every health issue that comes up on vacation qualifies as an emergency. Situations that are uncomfortable but not life-threatening, such as a sinus infection, sprained ankle, UTI, or prescription refill, may fall outside of emergency coverage depending on your plan type.
HMO and EPO plan members are most at risk in these scenarios. PPO plans, which offer flexibility to see providers nationwide without referrals, are better suited for travelers, but they are less common among individual marketplace plans.
“Most state-based marketplaces don’t offer PPO plans to individuals,” said Colrick. “If you purchased your plan through a state exchange, there’s a good chance you’re on an HMO or EPO and that can really limit your options when you’re traveling and need non-emergency care.”
8 Things to Do Before You Leave for Vacation
Colrick recommends taking the following steps before traveling this summer:
- Review your plan’s coverage area. Check whether your health plan covers care at your destination. Most domestic plans do not cover care outside the country. If you are traveling internationally, consider purchasing a separate travel medical policy.
- Save a digital copy of your insurance ID card. Download or photograph your ID card and keep it accessible on your phone or saved to your email. Having quick access to your member ID helps providers verify your coverage and reduces delays in getting care.
- Know how to access telemedicine. Understand how to connect with your plan’s virtual care options before you travel. If you come down with a minor illness while away, telemedicine lets you speak with an in-network doctor without leaving your hotel or resort.
- Refill prescriptions before you go. Make sure you have enough medication to cover your entire trip. Getting a refill out of state, or out of the country, can be difficult or impossible.
- Understand what qualifies as an emergency. Review your plan’s definition of a medical emergency. Many plans offer nurse lines or care guidance services to help you determine whether to seek urgent care or go to an emergency room, a distinction that can have a significant effect on your costs
- Consider travel medical coverage for international trips. If you are traveling abroad, a separate travel medical policy can help protect against the cost of emergency care and medical evacuation. Some travel credit cards also include international medical coverage when used to book your trip. Check your card’s benefits before purchasing a separate policy.
- Check for member perks and travel support. Some health plans include travel assistance, care navigation services, or member discounts that can be valuable while you’re away. Review your plan’s member benefits before you leave.
- Share your insurance information with a travel companion. Make sure someone traveling with you knows how to access your insurance details in case you are unable to communicate during an emergency. This small step can make a significant difference in getting timely help.
For more information about OneHealth Plus, visit https://www.onehealthplus.com/.
